When people are treated for Irritable Bowel Syndrome (IBS), some may experience a Die-Off reaction. This term is thrown around a lot, but what exactly is Die-Off? What does it mean?

Die-off reaction is shorthand for a Herxheimer reaction (Jarisch-Herxheimer reaction), also known as herx or herxing. This term was coined to describe what Karl Herxheimer observed when he administered drugs to patients. Herxing was originally observed in patients with acute infections such as syphilis who received mercury treatment (a weak antibiotic).

The reaction occurs when toxins from injured or dying pathogens (viruses, bacteria, parasites, candida, etc.) overwhelm the body’s natural ability to clear them out. The liver, which is the body’s main pathway for eliminating toxins, becomes overwhelmed by the amount of endotoxins released into the blood and tissue. The release of toxins is faster than the body can comfortably handle and thus provokes a sudden and exaggerated inflammatory response.

The treatment of many bacterial infections is known to provoke a Herxheimer reaction. For example, in the infamous anthrax attacks, people died by the time they got to the hospital. This occurred because anthrax organisms (unlike most other organisms) multiply very quickly. When treated with an anti-bacterial medicine, the organisms had multiplied to the point where killing them overwhelmed the body with a high concentration and rapid introduction of toxins into the bloodstream. This overload of toxins on the body ultimately resulted in death.

A 1980 study of the Herxheimer reaction found the following: “One phenomenon deserving emphasis is seen occasionally when therapy is initiated. It suggests the Herxheimer reaction … The reaction is usually limited to a flu-like syndrome of mild generalized aching and low-grade fever, but may also encompass an exacerbation of the patient’s allergic manifestations.” [1]

People experiencing Die-Off reaction often report feeling as if they have the flu or a cold. The whole body is generally sluggish and usually feels as if it is working harder – almost fighting something. There is an array of symptoms associated with Die-Off, including:

Essentially, the immune system kicks up an inflammatory storm as toxins move through and out of the body causing all sorts of symptoms. Treatment with an anti-inflammatory agent may stop progression of the reaction. In most cases, taking an aspirin or Ibuprofen will generally help with the inflammatory response, thereby giving relief to the symptoms. Die-Off should be seen as a positive sign when treating bacterial infections. It indicates that the bad bacteria are literally dying off. For example, in the case of IBS associated with Small Intestine Bacterial Overgrowth (SIBO), if you are treating it and start to experience Die-Off, you know that SIBO is the correct diagnosis. This means that Die-Off will run its course, end soon, and that you are close to relief from IBS issues!

Written by: Kenneth Brown, M.D.

[1] Restoration of Immunologic Competence to Candida Albicans by C. Orian Truss, M.D.1